Understanding the Initiation of Maintentenance Dialysis among Older Veterans

描述(由申请人提供)： 为患有终末期肾病的老年退伍军人启动维持性透析的决定，为提高专科护理的价值提供了最大的机会之一。与在生命末期进行的其他强化手术类似，老年人对透析的利用存在很大的地区差异，这表明终末期肾脏疾病的治疗强度取决于实践方式或医疗资源的供应，而不是受益的可能性。该项目的目标是确定潜在的差异来源 决定启动透析，并确定与接受透析与保守(非透析)护理相关的特定患者、提供者和设施特征。该项目还将 比较透析与保守护理管理策略的生存和卫生资源利用模式。为了实现这一目标，我们将利用退伍军人退伍军人索赔数据、实验室记录和详细的图表审查，组建一个接近终末期肾脏疾病的全国退伍军人队列。该项目的调查结果将为促进适当使用透析的干预措施和退伍军人政策的设计提供信息。

DESCRIPTION (provided by applicant): The decision to initiate maintenance dialysis for older veterans with end-stage renal disease affords one of the greatest opportunities to improve value in specialty care. Similar to other intensive procedures performed near the end of life, there are wide regional variations in the utilization of dialysis among older adults, suggesting that intensity of treatment for end-stage renal disease is determined by practice style or the supply of medical resources rather than the likelihood of benefit. The goal of this project is to determine the sources of variation underlying the decision to initiate dialysis and to identify specific patient, provider and facility characterstics associated with receipt of dialysis versus conservative (non-dialytic) care. This project will also compare the survival and health resource utilization patterns of dialysis versus conservative care management strategies. To accomplish this goal, we will assemble a national cohort of veterans approaching end-stage renal disease using VA claims data, laboratory records and detailed chart review. The findings from this project will inform the design of interventions and VA policies that promote appropriate use of dialysis.